Musculoskeletal Manifestations of Child Abuse: Analysis at a Level 2 Trauma Center in Puerto Rico

Claudio Ballester, David Beaton-Comulada, Marianna Oppenheimer, Manuel Antonio Ramirez, Lenny Rivera, Manuel Garcia-Ariz, Pablo V. Marrero


Objective: To describe the epidemiological manifestations and assess major risk factors in children under the age of three years presenting with non-accidental injury (NAI) fractures in a level two trauma center in Puerto Rico. Methods: An IRB approved retrospective descriptive study was performed by reviewing case records of 75 patients who presented with a NAI fracture at the Pediatric University Hospital of the Puerto Rico Medical Center. The study time period was from October 1996 to October 2014. The inclusion criteria for our population consisted of: (1) patients between the ages of zero to three years, (2) suffered a long bone fracture, and (3) had a history of suspected child abuse at our academic institution. The exclusion criteria were: (1) patients older than three years, (2) no history of NAI, or (3) had a congenital bone disorder. Results: A total of 117 long bone fractures were observed in our population. Similar distribution was seen between sex,, with 52% being male and 48% being female. The mean age was 10.8 months. The group with the highest frequency of NAI fractures were children under the age of one year (57.3 %). The most commonly involved fractured bone for all age groups was the femur (48.0 %). No statistical significance was observed when comparing sex, age, associated injuries or multiple fractures. Conclusion: Children younger than one year of age who present with long bone fracture, multiple fractures, low household income and parental unemployment are associated with an increased risk of NAI fractures.


child abuse; nonaccidental injury fracture; pediatric fracture; femur fracture

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